Has no real or apparent  conflicts of interest to report. Conflict of Interest Disclosure Jeff Belden MD
Understanding the Landscape of  EMR Usability   Implications for ARRA and Beyond
Jeff Belden MD <ul><li>Associate Professor of Clinical Family Medicine </li></ul><ul><li>University of Missouri - Columbia...
Objectives <ul><li>Define usability </li></ul><ul><li>List up to 10 principles of EMR usability </li></ul><ul><li>List usa...
What is usability?
Usability <ul><li>It’s  not  just “user satisfaction” </li></ul>
Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Speci...
Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Speci...
Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Speci...
Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Speci...
5  E s of Usability <ul><li>Effective </li></ul><ul><li>Efficient </li></ul><ul><li>Engaging </li></ul><ul><li>Error toler...
Can usability be measured? <ul><li>Yes it can </li></ul>
Counterpoint <ul><li>“ User friendly? There is simply no way you can  certify  such – end of story.” </li></ul><ul><li>Chi...
 
10 Principles of Usability <ul><li>Simplicity </li></ul><ul><li>Naturalness </li></ul><ul><li>Consistency </li></ul><ul><l...
Simplicity
Simplicity <ul><li>For doing refills </li></ul><ul><li>For overview only </li></ul>
Simplicity <ul><li>User:  Surgeon </li></ul><ul><li>Task:  Rounding </li></ul>
Minimize Cognitive Load Don’t make me think
Exact past dates <ul><li>This requires mental math </li></ul>
Relative past dates <ul><li>Easier. No extra thinking. </li></ul>
Hover to see more detail <ul><li>Have it both ways </li></ul>
Efficiency The most measurable
Efficiency – How Fast? <ul><li>Time to finish tasks </li></ul><ul><li>Click count </li></ul><ul><li>Other measures using M...
Dashboard efficiency
50 Clicks… <ul><li>6 minutes </li></ul>
… 2 Clicks <ul><li>1-2 minutes </li></ul>
Dashboard benefits <ul><li>Single visual plane </li></ul><ul><li>No navigation away needed </li></ul><ul><li>No need to re...
Hover Tool-tip
Windoid pop-up
Dashboard principle <ul><li>Show me  WINWINIANM </li></ul><ul><li>(what I need, when I need it, and nothing more) </li></ul>
Forgiveness Error tolerance
Forgiveness <ul><li>Let users recover gracefully from mistakes </li></ul>
Feedback
Feedback <ul><li>Don’t keep the user wondering </li></ul><ul><li>Show expected delays </li></ul><ul><li>Confirm changes th...
Feedback <ul><li>Imagine a user clicks a page element, and a long, slow database call ensues… </li></ul>
Acceptable
Better <ul><li>Please wait while we check 10,357 records… </li></ul>
Best <ul><li>Please wait while we check 10,357 records… </li></ul>Time remaining… 8 seconds
Poor <ul><li>Nothing changes visibly </li></ul><ul><li>What does the user think? </li></ul><ul><ul><li>Should I click agai...
Effective  Use of Language
Use of Language <ul><li>Use the user’s natural language </li></ul><ul><ul><li>Physician and nurse words both overlap and d...
Use of Language <ul><li>Be terse </li></ul><ul><li>First words are critical </li></ul>
First words matter <ul><li>Wrong sequence </li></ul><ul><li>Culture, blood, peripheral </li></ul><ul><li>Culture, blood, c...
Effective  Information Presentation
Information presentation Vertical text harder to read
Information presentation Horizontal text easier to read.  Takes up same space.
Naturalness
Naturalness <ul><li>Feels familiar </li></ul><ul><ul><li>Like real world </li></ul></ul><ul><ul><li>Works like the web </l...
 
ARRA  Usability Requirements for “meaningful use”
What ARRA has to say about usability <ul><li>nothing </li></ul>
So why should you care? <ul><li>90 %  of doctors surveyed said they are either “concerned” or “very concerned” about usabi...
David Blumenthal MD MPP  | ONCHIT <ul><li>…  many certified EHRs [not]  user-friendly  … </li></ul>“ …  many certified EHR...
<ul><li>[CCHIT will] pilot test a 'first step' basic  usability assessment program … </li></ul>“ [CCHIT will] pilot test a...
 
Shopping for EMR? Here are some tips
No online stores yet
Ratings <ul><li>Available but restricted </li></ul><ul><ul><li>KLAS (for users who rated their own) </li></ul></ul><ul><ul...
Make a shopping list <ul><li>Create clinical scenarios to test </li></ul><ul><li>Time critical tasks </li></ul><ul><ul><li...
Creating clinical scenarios <ul><li>Choose ones that matter </li></ul><ul><ul><li>common, important </li></ul></ul><ul><ul...
Try out reporting function <ul><li>What will you want to report? </li></ul><ul><ul><li>A1Cs in diabetics </li></ul></ul><u...
Don’t be “wowed” by templates <ul><li>Don’t be impressed with installed templates </li></ul><ul><ul><li>Try them out first...
Still need help? <ul><li>Use our online shopping checklist </li></ul><ul><li>http://bit.ly/shopEMR </li></ul>
Want to learn more? <ul><li>Read more about principles & methods of testing </li></ul><ul><li>http://bit.ly/UsabilityHIMSS...
Want to learn more? <ul><li>How to do simple usability testing </li></ul><ul><li>http://bit.ly/lo4Wn </li></ul>
Thanks <ul><li>HIMSS EMR Usability Task Force </li></ul><ul><li>Authors </li></ul><ul><ul><li>Janey Barnes PhD </li></ul><...
Questions?
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EMR Usability - HIMSS Virtual Conf 09

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Slides from my closing keynote presentation at HIMSS Virtual Conference, November 4, 2009.

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EMR Usability - HIMSS Virtual Conf 09

  1. 1. Has no real or apparent conflicts of interest to report. Conflict of Interest Disclosure Jeff Belden MD
  2. 2. Understanding the Landscape of EMR Usability Implications for ARRA and Beyond
  3. 3. Jeff Belden MD <ul><li>Associate Professor of Clinical Family Medicine </li></ul><ul><li>University of Missouri - Columbia </li></ul><ul><li>Chair – HIMSS Task Force on EMR Usability </li></ul>
  4. 4. Objectives <ul><li>Define usability </li></ul><ul><li>List up to 10 principles of EMR usability </li></ul><ul><li>List usability requirements for “meaningful use” </li></ul><ul><li>Use a checklist when looking for usability in an EMR </li></ul>
  5. 5. What is usability?
  6. 6. Usability <ul><li>It’s not just “user satisfaction” </li></ul>
  7. 7. Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Specific users </li></ul></ul><ul><ul><li>Specific set of tasks </li></ul></ul><ul><ul><li>Particular environment </li></ul></ul>
  8. 8. Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Specific users </li></ul></ul><ul><ul><li>Specific set of tasks </li></ul></ul><ul><ul><li>Particular environment </li></ul></ul>
  9. 9. Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Specific users </li></ul></ul><ul><ul><li>Specific set of tasks </li></ul></ul><ul><ul><li>Particular environment </li></ul></ul>
  10. 10. Usability is <ul><li>Effectiveness </li></ul><ul><li>Efficiency </li></ul><ul><li>Satisfaction </li></ul><ul><ul><li>Specific users </li></ul></ul><ul><ul><li>Specific set of tasks </li></ul></ul><ul><ul><li>Particular environment </li></ul></ul>
  11. 11. 5 E s of Usability <ul><li>Effective </li></ul><ul><li>Efficient </li></ul><ul><li>Engaging </li></ul><ul><li>Error tolerant </li></ul><ul><li>Easy to learn </li></ul>
  12. 12. Can usability be measured? <ul><li>Yes it can </li></ul>
  13. 13. Counterpoint <ul><li>“ User friendly? There is simply no way you can certify such – end of story.” </li></ul><ul><li>Chilmark </li></ul><ul><li>chilmarkresearch.com </li></ul>
  14. 15. 10 Principles of Usability <ul><li>Simplicity </li></ul><ul><li>Naturalness </li></ul><ul><li>Consistency </li></ul><ul><li>Minimizing cognitive load </li></ul><ul><li>Efficient interactions </li></ul><ul><li>Forgiveness </li></ul><ul><li>Feedback </li></ul><ul><li>Effective use of language </li></ul><ul><li>Effective information presentation </li></ul><ul><li>Preservation of context </li></ul>
  15. 16. Simplicity
  16. 17. Simplicity <ul><li>For doing refills </li></ul><ul><li>For overview only </li></ul>
  17. 18. Simplicity <ul><li>User: Surgeon </li></ul><ul><li>Task: Rounding </li></ul>
  18. 19. Minimize Cognitive Load Don’t make me think
  19. 20. Exact past dates <ul><li>This requires mental math </li></ul>
  20. 21. Relative past dates <ul><li>Easier. No extra thinking. </li></ul>
  21. 22. Hover to see more detail <ul><li>Have it both ways </li></ul>
  22. 23. Efficiency The most measurable
  23. 24. Efficiency – How Fast? <ul><li>Time to finish tasks </li></ul><ul><li>Click count </li></ul><ul><li>Other measures using Morae </li></ul>
  24. 25. Dashboard efficiency
  25. 26. 50 Clicks… <ul><li>6 minutes </li></ul>
  26. 27. … 2 Clicks <ul><li>1-2 minutes </li></ul>
  27. 28. Dashboard benefits <ul><li>Single visual plane </li></ul><ul><li>No navigation away needed </li></ul><ul><li>No need to recall last screen’s content </li></ul><ul><li>Use hover-over, or pop-up windoids </li></ul>
  28. 29. Hover Tool-tip
  29. 30. Windoid pop-up
  30. 31. Dashboard principle <ul><li>Show me WINWINIANM </li></ul><ul><li>(what I need, when I need it, and nothing more) </li></ul>
  31. 32. Forgiveness Error tolerance
  32. 33. Forgiveness <ul><li>Let users recover gracefully from mistakes </li></ul>
  33. 34. Feedback
  34. 35. Feedback <ul><li>Don’t keep the user wondering </li></ul><ul><li>Show expected delays </li></ul><ul><li>Confirm changes that aren’t evident </li></ul>
  35. 36. Feedback <ul><li>Imagine a user clicks a page element, and a long, slow database call ensues… </li></ul>
  36. 37. Acceptable
  37. 38. Better <ul><li>Please wait while we check 10,357 records… </li></ul>
  38. 39. Best <ul><li>Please wait while we check 10,357 records… </li></ul>Time remaining… 8 seconds
  39. 40. Poor <ul><li>Nothing changes visibly </li></ul><ul><li>What does the user think? </li></ul><ul><ul><li>Should I click again? </li></ul></ul><ul><ul><li>Did the application lock up? </li></ul></ul>
  40. 41. Effective Use of Language
  41. 42. Use of Language <ul><li>Use the user’s natural language </li></ul><ul><ul><li>Physician and nurse words both overlap and diverge </li></ul></ul><ul><ul><li>Managers speak non-clinical language </li></ul></ul>
  42. 43. Use of Language <ul><li>Be terse </li></ul><ul><li>First words are critical </li></ul>
  43. 44. First words matter <ul><li>Wrong sequence </li></ul><ul><li>Culture, blood, peripheral </li></ul><ul><li>Culture, blood, central line </li></ul><ul><li>Culture, urine, catheter </li></ul><ul><li>Culture, urine, clean-voided </li></ul><ul><li>Better sequence </li></ul><ul><li>Blood , peripheral (culture) </li></ul><ul><li>Blood, central line (culture) </li></ul><ul><li>Urine, catheter (culture) </li></ul><ul><li>Urine, clean-voided (culture) </li></ul>
  44. 45. Effective Information Presentation
  45. 46. Information presentation Vertical text harder to read
  46. 47. Information presentation Horizontal text easier to read. Takes up same space.
  47. 48. Naturalness
  48. 49. Naturalness <ul><li>Feels familiar </li></ul><ul><ul><li>Like real world </li></ul></ul><ul><ul><li>Works like the web </li></ul></ul><ul><li>Easy to learn </li></ul>
  49. 51. ARRA Usability Requirements for “meaningful use”
  50. 52. What ARRA has to say about usability <ul><li>nothing </li></ul>
  51. 53. So why should you care? <ul><li>90 % of doctors surveyed said they are either “concerned” or “very concerned” about usability as a leading obstacle to EHR adoption. </li></ul><ul><li>Nuance survey, June 2009 </li></ul>90 % concerned about usability
  52. 54. David Blumenthal MD MPP | ONCHIT <ul><li>… many certified EHRs [not] user-friendly … </li></ul>“ … many certified EHRs [not] user-friendly … “
  53. 55. <ul><li>[CCHIT will] pilot test a 'first step' basic usability assessment program … </li></ul>“ [CCHIT will] pilot test a 'first step' basic usability assessment program … “
  54. 57. Shopping for EMR? Here are some tips
  55. 58. No online stores yet
  56. 59. Ratings <ul><li>Available but restricted </li></ul><ul><ul><li>KLAS (for users who rated their own) </li></ul></ul><ul><ul><li>AAFP (Family Physician members only) </li></ul></ul>
  57. 60. Make a shopping list <ul><li>Create clinical scenarios to test </li></ul><ul><li>Time critical tasks </li></ul><ul><ul><li>Set targets (6 clicks for simple acute illness) </li></ul></ul><ul><ul><li># of clicks, time to complete task </li></ul></ul><ul><li>Have your group do qualitative ratings </li></ul><ul><ul><li>Use some of our 10 principles </li></ul></ul><ul><li>Test the EMRs reporting function </li></ul>
  58. 61. Creating clinical scenarios <ul><li>Choose ones that matter </li></ul><ul><ul><li>common, important </li></ul></ul><ul><ul><li>Include prescribing </li></ul></ul><ul><ul><li>Include “hey-doc” request </li></ul></ul><ul><li>Test them </li></ul><ul><li>Look for efficiencies </li></ul><ul><ul><li>(e.g. document normal ROS with one click?) </li></ul></ul>
  59. 62. Try out reporting function <ul><li>What will you want to report? </li></ul><ul><ul><li>A1Cs in diabetics </li></ul></ul><ul><ul><li>BP control rates in hypertension </li></ul></ul><ul><ul><li>List of patients on a particular recalled drug </li></ul></ul><ul><li>Should be easy </li></ul><ul><ul><li>Out of the box, or </li></ul></ul><ul><ul><li>Easy to make quickly </li></ul></ul>
  60. 63. Don’t be “wowed” by templates <ul><li>Don’t be impressed with installed templates </li></ul><ul><ul><li>Try them out first! </li></ul></ul><ul><li>Don’t expect clinicians to create or edit </li></ul><ul><li>Try to make some </li></ul><ul><li>Ideal: easy to make on the fly </li></ul>
  61. 64. Still need help? <ul><li>Use our online shopping checklist </li></ul><ul><li>http://bit.ly/shopEMR </li></ul>
  62. 65. Want to learn more? <ul><li>Read more about principles & methods of testing </li></ul><ul><li>http://bit.ly/UsabilityHIMSS </li></ul>
  63. 66. Want to learn more? <ul><li>How to do simple usability testing </li></ul><ul><li>http://bit.ly/lo4Wn </li></ul>
  64. 67. Thanks <ul><li>HIMSS EMR Usability Task Force </li></ul><ul><li>Authors </li></ul><ul><ul><li>Janey Barnes PhD </li></ul></ul><ul><ul><li>Rebecca Grayson </li></ul></ul><ul><ul><li>Jeff Belden MD </li></ul></ul><ul><li>Team Leaders </li></ul><ul><ul><li>Penn White MD </li></ul></ul><ul><ul><li>Tiana Thomas </li></ul></ul>
  65. 68. Questions?

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